Capitol Hill Report: Another Short Term Fix

May 25, 2010

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By Mike Amery, Legislative Counsel, Federal Affairs, (202) 349-4299, mamery@aan.com

Leadership of the Senate Finance Committee and House Ways and Means Committee released a statement last week describing an agreement reached on postponing the 21-percent cut in physician reimbursement scheduled for May 30, 2010. According to the release:

"Medicare physician payment rates are scheduled to be reduced by more than 20 percent in June. This provision would provide reasonable updates in physician payment rates for the rest of this year and next year. For 2012 and 2013, rates would continue to increase if spending growth on physician services is within reasonable limits, with an extra allowance for primary and preventive care. Rates could not be reduced in 2012 or 2013, but after that rates would return to their current law levels."

The one good thing about this is that Congress has moved away from designating "extra allowance for primary care" by listing specialties and now defines it by CPT code so neurologists will benefit.  This is contrary to the health reform bill that excluded neurology for a "primary care incentive" by listing eligible specialties.  Perhaps Congress is starting to listen to us...

The Academy's Position

The Academy's Government Relations Committee and Medical Economics and Management Committee conducted serious debate over the last week on whether the Academy should continue to push for a permanent fix or support the short-term solutions bring floated on Capitol Hill.  The consensus from both committees was that this problem is only getting worse and the Academy needed to continue pushing for a permanent solution.

For some time there was discussion in Congress of a five-year temporary fix, which makes today's $200 billion problem a $500 billion problem five years from now. However, even with the agreed upon 3.5 year fix, the numbers are getting so high that it is unlikely Congress will ever be able get a permanent repeal of the flawed Sustainable Growth Rate (SGR) formula. Yet, everyone on Capitol Hill agrees that physicians are never going to see 20-percent-plus cuts. Members of Congress understand that today it is physicians asking for help, but tomorrow it could be Medicare beneficiaries with no doctors to see.

Don't Forget to Log on to Vocus

Last Wednesday the Academy sent out an action alert to all US members asking that you contact your members of Congress in support of a permanent repeal of the SGR and opposition to a short-term fix.

This doesn't mean the Academy supports the cut. Members of Congress looking to be re-elected can't afford to make this issue a patient access crisis so a 21-percent cut just isn't going to happen.

But they need to continue to get the message that this fix needs to be permanent. If you have not sent your message, please log on to the Academy's online advocacy program, Vocus, to quickly and easily send a message.

Talking with the Right People

Last week I had the honor of meeting with the Speaker of the House, Nancy Pelosi (D-CA).  In addition to talking with her about our desire for a permanent repeal of the SGR, I also made her aware of the primary (cognitive) care incentive and the omission of neurology. Although I had discussed the issue with her staff in the past, she asked me to follow up on the issue with her office, which I did the next day.

Academy Member Dr. Marc Nuwer of Los Angeles, CA, also met with the Speaker last Saturday at in event in California.

"I had time with the Speaker twice for about five minutes.  She was already aware that neurology needs to be considered when Congress revisits the health bill," said Nuwer.  "I said we would have Academy Washington staff continue to work with her on the issue, which she said she would appreciate."

At the same event, Nuwer also met with Congressman Xavier Becerra (D-CA) a key member of the House Ways & Means Committee. "We sat together at a small table for dinner for about 90 minutes.  The conversation kept coming back to health care which he welcomed."

Nuwer said the Speaker has delegated many details of the health care legislation to Becerra, including any upcoming technical corrections. "He agreed that the Neurology primary care issue needed to be addressed."

Dr. Nuwer's confirmation that Speaker Pelosi is aware of our issue could lead to good things. We are also continuing to get the ear of Becerra who met with Academy Government Relations Committee and BrainPAC Executive Committee member Tom Vidic in February and with me several times over the last few months.

There is no question that we're talking with talking with the right people.